April 1, 2010
by Annick Ducharme, RDH
Are you a dentist?
Oh no, I’m “just” a dental hygienist!
I’ve often heard that disparaging remark, such a short sentence but so infinitely revealing of a person’s perception of his or her profession. Unfortunately, it conveys a negative image of a highly important and comprehensive profession that is far from being a mere accessory to the world of dentistry.
I have been a dental hygienist by profession for nearly 13 years. I was fortunate to have the opportunity to work in several areas of dentistry with some very good hygienists and dentists who shared their knowledge of and passion for dentistry with me and I’m trying to do the same in return.
After starting out in family dentistry, I quickly learned micro-dentistry and moved on to inserting filling materials. Next, I was taught all the principles of providing treatments plans, including periodontal care. I also learned about the world of surgery as a surgical planner and assistant: sinus lifts, bone grafts and oral implants. My career has provided me with an overview of orthodontics and community health, too. Finally, while replacing someone on maternity leave, I worked in a clinic that was almost exclusively devoted to cosmetic dentistry. The job entailed a number of expanded responsibilities such as making temporaries and assisting in setting crowns and bridges. Then one day, the super hygienist I’d been replacing came back from her long absence and my fate was sealed because what they needed at the clinic was… someone to do cleanings. How disappointing!!!
What a shame, with all my knowledge and background. How would I be able to stand it? But since my kids need milk (as the dentist I work with would say), I decided to accept my fate, telling myself that when I’d had enough of working under those conditions I’d start looking for a new job more in line with my skills.
Here I am nearly two years later still working the same hours at the same job and happy to be doing it. I wouldn’t trade my job for any other and if circumstances compelled me to move somewhere else, I wouldn’t hesitate for one second to apply for a straight hygienist position, i.e. doing the basics of the profession. In the following paragraphs, I will try to share my passion for duties that are considered demeaning, but that nonetheless can be extremely gratifying.
First of all, I’d like to say that I sincerely believe this profession should constantly broaden the skills it encompasses because we are health professionals with a great deal of underutilized knowledge, ability and potential. I even believe that becoming skilled in several fields of practice can contribute significantly to our dental hygiene expertise and the way we advise our clients. But I also believe we should never forget our roots and should bear in mind that going back to the basics of our profession can be nothing short of beneficial.
A dental team is like the human body. Each member plays an important role in overall performance. Everyone agrees on that point. But for practical reasons, my comments here will focus primarily on the dentist, the dental hygienist and their patient.
You have to consider the dentist you work with as a partner, an equal. He is not your superior. He needs our qualifications as much as you need his and don’t ever forget that! One of my goals during a routine visit is to ensure that the dentist spends as little time as possible in my room. Nothing personal, mind you, but you have to remember that the patient has an appointment first and foremost with you, on your schedule, for your skills and you can lighten the dentist’s work because you have the knowledge that enables you to do so.
When the time comes for the dentist to perform his exam and make his diagnosis, everything he needs can be ready. Well-formulated preliminary observations: TMJ, attached gingiva, soft tissue, hard tissue, occlusion, periodontium; the periodontal chart should be available if needed, the seals of fillings should be checked, edentulous spaces noted, as well as possible treatments to replace them; you should also have an outside referral ready, if necessary, along with your fully completed file. You need your dentist for certain things that are his responsibility, but you can slowly train your eye and judgement so that eventually you’ll only have to wait for the dentist to confirm your assessment.
To do this, you will first need to establish a good clinical protocol together with your dentist. As surprising as it may seem, very few dental hygienists and dentists have taken the time before teaming up to share their concept of dental health, discuss what they expect of one another and their goals in order to have a common approach. Why? Because a regular visit is viewed as a simple, routine procedure: “It’s just a cleaning.” For people who think like that, it’s high time to realize that it is the perfect opportunity to make their patients aware of what is needed to optimize their health and give them all the necessary facts to make informed decisions about possible dental treatments. When the diagnosis is made, if patients lack information or if the information has not been explained in lay terms, they may not understand the importance of the care that is being suggested and might not follow up on it.
In the clinic where I work, for instance, we have a simple golden rule that cuts down considerably on discussion between my dentist and me concerning the observations I made during the visit. In any case, patients often don’t understand what we’re talking about. We put a minimum of four intra-oral images on the computer screen, the first showing the lingual surface of the lower central incisors so the dentist can quickly see the type of scaling that was done. This is followed by three or more images of things I would like him to check or comment on. Naturally, the patient needs to be given preliminary information and explanations beforehand. You also have to make sure patients understand that they are waiting for the diagnosis of the dentist who will then point them in the right direction for appropriate treatment.
I am not saying that this is the only way to proceed and that you need to adopt this rule to make dental visits successful. The important thing to retain from this example is that you and your dentist should be in perfect sync so that routine dental visits run as smoothly as possible. Therefore, if you haven’t already done so, ask to meet with your dentist.
Imagine how lucky you are: you have access to a human laboratory. You are the one in charge of finding solutions to hygiene problems and you even have the opportunity to see the outcomes of your suggestions a few months later; if the results aren’t satisfactory, you have a chance to make different suggestions! And if, on the other hand, you achieved your goal, that’s a joy in itself.
I try to involve all my patients in what I’m doing by clearly describing the things I noted in their file that we need to keep an eye on. I try to explain my goals and make patients aware of how important it is for me to see them again in a few months for a check-up as well as a cleaning. I make sure to set up their appointment myself in 3, 6, 9 or 12 months. I explain the reasons and usually the next appointment is more significant.
Therefore, it’s only logical that at the beginning of each appointment with my patients I summarize the previous visit to remind them that I’m watching out for their health, that I have the situation well in hand and that they can have confidence me. Following your preliminary observations, don’t hesitate to let them know about everything you’re looking at: tell them that you measured their bone level, checked their soft tissue, looked at their throat, TMJ, occlusion… The only way for patients to know that your responsibilities extend beyond cleaning is for you to tell them, and they will be reassured to see th
at the dental team is watching out for their health.
Regardless of age, sex or religion, people all need gratification. Everyone appreciates knowing when they’re doing something right. Therefore, I always make it a point to find something positive during each visit to reinforce good habits. My ideology in my practice is to never “scold” my patients. Instead, my role is to explain the consequences to them and give them a sense of responsibility about their choices without making them feel they’re being judged.
Routine, you say? I can’t claim that this work doesn’t involve a certain amount of routine. But don’t you think that, from a practical viewpoint, other dental procedures are just as routine? Fillings, crowns, endodontics are just sequential steps in a series, some of which are timed to the second. Consider the garage mechanic who changes the tires on your car or the bus driver who always takes the same route. From manicures to mammograms, most jobs require a logical sequence of actions in order to be performed according to the rules of the trade and our profession is one of them. To me, routine means performing acts that seem insignificant to you, but I think the procedures I carry out daily for the good of my patients are far from insignificant.
If there is just one thing that you retain from everything I’m sharing with you, I hope it will be this: Explore all facets of dentistry. Never be daunted by statements like:
“Recommended for: dentists, dental technicians, denturists”
It certainly doesn’t say anywhere that hygienists aren’t allowed to take part. On the contrary, your participation will help bring us the recognition we deserve in the world of dentistry, i.e. as health professionals.
In my opinion, one of the strong points of dental hygienists is their broad knowledge and ability to communicate. Go ahead, learn about new dental materials! Ask for a tour of your dental lab to familiarize yourself with the steps involved in making a coronal prosthesis with a support post! Ask your denturist to explain the difference between equilibrated and standard dentures! Take advantage of ongoing training to find out the difference between porcelain, ceramic-metal and zirconium crowns! Ask a surgeon to let you watch implant surgery. If the surgeon is open to the idea, go for it!
Our dental secretary took part in a practical course on making temporaries! Pointless, you say? Now, when patients call with questions about crowns or bridges, she knows exactly what to tell them. She can provide satisfactory answers to patients’ questions and make appointments without having to ask anyone. But the best part is that she knows what’s involved. She’s not merely going through the motions! If you want to offer your clients options, you first need to understand the options and be able to answer basic questions. As you’ll see, it’s highly stimulating.
Sometimes I spend several minutes in the dental care aisle at the pharmacy looking at all kinds of things. Some products are useful, others should not be recommended. I also check the prices, new items and differences in the way additives are listed since it’s not unusual for patients to say they can’t find a certain product. That’s usually because the packaging is different from the samples you give them, and you can let them know.
Ongoing training is required in most provinces. Consider it as an opportunity. Take advantage of it to acquire knowledge in an area you never explored before. Obviously, we have to stay abreast of advancements in our own field of practice, but you should never sign up for courses on topics you know well enough to actually teach just to have the mandatory hours of required training.
The first recorded licenses to practice were issued in Ontario in 1951. Since that time, the dental hygienist profession has been constantly evolving. Despite the profession’s newness, there are about 20,000 dental hygienists across Canada, according to the most recent data. The beauty of this profession today is that it offers a multitude of options to its members! Each task is indispensable. We are all unique and that is what makes us strong and diversifies our fields of practice. Despite all our differences, we must preserve our sense of belonging and our passion for dental hygiene by being proud to introduce ourselves as dental hygienists. OH
Annick Ducharme is currently a valued member of Dr. Elliot Mechanic’s team in Montreal. This graduate from Trois-Rivieres Cegep as well as the University of Montreal, has been the recipient of le Prix du Lecteur on two separate occasions. Such honors have been awarded to her by her peers for the publication of her articles in OHDQ dental magazine. Annick Ducharme has sat on the board of multiple committees for the OHDQ and CADC but is also recognized as a distinguished guest speaker for several associations. Among them, Diabete Quebec and Les Salons de la famille. Envoy de mon iPhone
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